NPIMap

Organization Active NPI

Shoolin LLC

  • Hospitalist Physician
  • Edmond, OK
National Provider Identifier
1972012722
Registry record updated Feb 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
27981 Issued in OK
Legal business name
SHOOLIN LLC
Practice address
105 S Bryant Ave Ste 101
Edmond, OK 73034-6330
Phone
(405) 861-0004
Fax
(855) 680-8890
NPI assigned
Sep 25, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rakesh Shrivastava, MDNPI 1043250863
Title
Owner
Phone
(405) 642-8613

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 27981 OK
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X 27981 OK
Interventional Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0011X 27981 OK
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X 27981 OK Primary

Addresses

Primary practice location

105 S Bryant Ave Ste 101
Edmond, OK 73034-6330

Mailing address

PO Box 8350
Edmond, OK 73083-8350
Phone (405) 861-0004

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171019000878 OK Part B Supplier - Clinic/Group Practice 0840566881 Receives reassigned benefits from 4 practitioners
Practice locations: Edmond, OK

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644969600000",
    "number": "1972012722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8350",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730838350",
            "telephone_number": "405-861-0004",
            "fax_number": "855-680-8890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S BRYANT AVE STE 101",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730346330",
            "telephone_number": "405-861-0004",
            "fax_number": "855-680-8890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOOLIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-25",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A",
        "authorized_official_last_name": "SHRIVASTAVA",
        "authorized_official_first_name": "RAKESH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-642-8613",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "27981",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OK",
            "license": "27981",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "OK",
            "license": "27981",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": "OK",
            "license": "27981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.